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Abstract: PO0680

Adding Heparin to Citrate in Continuous Renal Replacement Therapy May Extend Filter Lifespan in COVID-Related AKI

Session Information

Category: Coronavirus (COVID-19)

  • No subcategory defined

Authors

  • Valle, Eduardo de Oliveira, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Albuquerque, Claudia Coimbra, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Sandoval Cabrera, Carla Paulina, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • da Silva, Giovanio Vieira, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Smolentzov, Igor, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Reichert, Bernardo V., Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Andrade, Lucia, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Lins, Paulo Ricardo Gessolo, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Seabra, Victor F., Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Rodrigues, Camila Eleuterio, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
Background

COVID may predispose patients to thrombosis and lower filter lifespan. Association between D-dimer level (DD) and filter clotting in Continuous Renal Replacement Therapy (CRRT) has not been described.

Methods

All patients who needed CRRT in Hospital das Clínicas (Brazil) during March to May 2020 (COVID related-AKI (COV+), n=37) and August to September 2019 (COVID unrelated-AKI (COV-), n=18) were studied. Anticoagulation in CRRT in COV+ was done with citrate 3mmol/L (ACD, n=19), or citrate 4mmol/L plus non-fractioned heparin 10U/Kg/h (ACD/Hep, n=18), while in COV- with citrate 3mmol/L only. Data are expressed in median [IQR]. We performed Spearman's correlation between DD and time-free of filter clotting (TFC), and Kaplan-Meier curve to study filter survival by anticoagulation method and DD.

Results

ACD/Hep group presented lower filter clotting in 72h when compared to other groups (ACD/Hep: 35% vs ACD: 100% vs COV-: 80%, p< 0.05). Analyzing filter clotting per patient-day, ACD/Hep also presented less clotting than ACD group (ACD/Hep: 41% vs ACD: 100%, p< 0.05). In COVID patients, median TFC was 33.5 h [17.0;72.0] (ACD: 29.0 h [13.0;68.5], ACD/Hep: 40.0 h [17.0;62.0], p: NS). Clotting time from obese patients did not differ from non obese patients (obese: 31.0 h [18.5;57.2] vs non-obese: 56.0 h [16.8;72.0], p: ns). Median DD in all COVID patients was 3,519 [1420-13,883]. Patients with DD below median (<3,500) had higher TFC (ACD high DD: 19.0 h [9.00;27.5], ACD/Hep high DD: 34.0 [17.0;62.0], ACD low DD: 57.0 h [27.2;66.8], ACD/Hep low DD: 67.0 h [26.0;72.0]; Figure 1). There was statistically significance in correlation between DD and TFC in ACD patients, but not in ACD/Hep group.

Conclusion

Heparin may extend filter lifespan in CRRT, and this benefit seem to be greater in high DD patients.

Funding

  • Government Support - Non-U.S.